Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.  IN ADDITION, PLEASE NOTE THAT OUR PARTNERSHIPS AND AFFILIATIONS MAY HAVE THEIR OWN PRIVACY NOTICE THAT SHOULD BE REVIEWED CAREFULLY.

If you have any questions about this notice, please contact America’s Sleep Network, Incorporated at 630-655-4803.

Section A: Who will follow this notice?

This notice describes the practices of America’s Sleep Network Incorporated. (herein referred to as ASN), which includes the following entities:

- All Practicing physicians, Nurses and Medical Assistants, Respiratory Therapists, and Polysomnograph Technologists, Clerical Staff, Billing Clerks, Office Administration, partnerships, and affiliations.

The privacy Notice pertain to all offices in which ASN practice, and conducts sleep studies.  All ASN staff and personnel at these sites and locations follow the terms of this notice.  In addition, these entities, sites, and locations may share medical information with each other for treatment, payment or health care operation purposes described in this notice. 

Section B: Our Pledge Regarding Medical Information.

We understand that medical information about you and you health is personal.  We are committed to protecting medical information about you.  We create a record of the care and services you receive at ASN and we need this record to provide you with quality care and to comply with certain legal requirements.  This notice applies to all of the records of your care generated or maintained by ASN, whether made by our personnel or obtained from outside of ASN through release of medical information. 

This notice will tell you about t he ways in which we may use and disclose medical information about you.  It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. 

We are required by law to:

- Use our best efforts to keep private and medical information that identifies you, give you this notice of our legal duties and privacy practices with respect to medical information about you; and follow the terms of the notice that is currently in affect.

Section C: How We May Use and Disclose Medical Information About You:

The following categories describe different way that we use and disclose medical information.  For each category of uses or disclosures we will explain what we mean.  Not every use or disclosure category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

- Treatment:  we may use medical information to provide you with medical treatment services.  We may disclose medical information to doctors, nurses, technicians, respiratory therapists, medical students, or other ASN personnel who are involved in taking care of you.  Different physicians, nurses, and medical staff may share medical information in order to coordinate the different things you need such as prescriptions, lab work, x-rays.  We also may disclose medical information to people outside ASN who may be involved in your medical care such as family members or others we use to provide services that are part of your care such as medical equipment companies. 

- Payment:  we may use and disclose medial information so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or a third party.  We may also tell your health plan about treatment you are going to receive to obtain prior authorization or to determine whether your plan will cover treatment. 

- Health Care Operations:  We may use and disclose medical information for operations.  These uses and disclosures are necessary to make sure that all of our patients receive quality care.  We may also combine medical information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.  We may also disclose information to doctors, burses, technicians, medical students, and other personnel for review and learning purposes.  We may also coming the medical information we have with medical information from other entities to compare how we are doing and see where we can make improvements in the care and services we offer.  We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

- Appointment Reminders:  We may use and disclose medical information to contact you as a reminder that you have an appointment for testing, treatment, or medical care.

- Treatment Alternatives:  We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. 

- Health related Benefits and Services:  we may use and disclose medical information to tell you about health related benefits or services that may be of interest to you.

-  Individuals Involved in your care or payment for your care: we may release medical information to a friend or family member who is involved in y our medical care.  We may also give information to someone who helps pay for your care.

- Research:  Under certain circumstances we may use and disclose medical information for research purposes.  All research projects are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients need for privacy of their medical information.  Before we use or discloses medical information for research the project will have been approved through this research approval process, but we may however, disclose medical information to people preparing to conduct a research project, so long as the medical information they review does not leave ASN.  We will generally ask you for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care. 

- As required by law:  we will disclose medical information when required to do so by federal, state, or local law.

- To avert a serious threat to health or safety: we may use and disclose medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.  Any disclosure, however, would only be someone able to prevent the threat. 

Section D: Special Situations

-  Military Veterans:  if you are a member of the armed forces, we may release medical information as required by military command authorities.  We may also release medical information about foreign military personnel to the appropriate foreign military authority. 

- Workers compensation: we may release medical information for workers compensations or similar programs.  These programs provide benefits for work related injuries or illness.

- Public Health Risks:  we may disclose medical information for public health activities. These activities generally include the following:  to prevent or control disease, injury or disability, to report deaths, to report abuse or neglect, to report reactions to medication or problems with products, to notify people of recalls of products they may be using, to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition, to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.  We will only make this disclosure if you agree or when required or authorized by law.  

- Health Oversight Activities:  We may disclose medical information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits investigations, inspection, and licensure.  These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

- Lawsuits and disputes:  if you are involved in a lawsuit or a dispute, we may disclose medical information in response to a court or administrative order.  We may also disclose medical information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

- Law Enforcement: we may release medical information if asked to do so by a law enforcement official:  in response to a court order, subpoena, warrant, summons, or similar process, to identify or locate a suspect, fugitive, material witness, or missing person, about the victim of a crime if; under a certain limited circumstance, we are unable to obtain the person agreement, in emergency circumstance to report a crime, the location of the crime, or victims or  the identity, description, or location of the person who committed the crime. 

Section E: Your Rights Regarding medical Information About you:

You have the following rights regarding medical information we maintain about  you:

-  Right to inspect and copy: you have the right to inspect and copy some of the medical information that may be used to make decision about your care.  Usually, this includes medical billing records.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

We may deny your request to inspect and copy medical information In certain circumstance.  If you are denied access to medical information, in some cases, you may reviews that the denial be reviewed.  Another licensed health care professional at ASN will review the request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review.

-  Right to Amend: if you feel that medical information we have about is incorrect or incomplete, you may ask us to amend the information.  You have the tight to request an amendment for as long as the information is kept by ASN.  In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  In addition, we may deny your request if you ask us to amend information that was not created by us, unless the person or entity that created the information is no longer available to make the amendment; is not part of the medical information kept by ASN’ is not part of the information which you would be permitted to inspect and copy, or is accurate and complete. 

-  Right to an accounting of Disclosures:  the practice tracks all disclosures of a patients’ protected health information that occur for other than the purpose of treatment, payment, and health care operations, that are not made to the individual or to a person involved in the patients’ care, that are not made as a result of a patient authorization, and that are not made for national security or intelligence purposes or to correctional institution or law enforcement officials.  Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003.  The first List you request within a 12 month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before costs are incurred. 

- Right to restrict restriction: you have the right to request a restriction or limitation on the medical information we use or disclose for treatment, payment, or health care operation.  You also have the right to request a limit on the medical information we disclose to someone who is involved in your care or the payment for your care, like a family member or friend.  In your request you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; (3) to whom you want to limits to apply, for example disclosures to your spouse. We are not required to agree to your request.  If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

- Right to request confidential communications:  For the purposes of communication of clinic visits and medical or billing matter, we will contact you by mail at the location you provide on the patient information sheet.  If you need to be contact by phone, our office will contact you at the home, work, or other phone numbers you provide the office staff.  At times we may leave messages on voice mail, phone machines, or with others who answer the phone at the numbers provided.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you which to be contacted. 

- Right to a paper copy of this Notice:  You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.

Section F: Changes to this notice:

We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.  We will post a copy of the current notice in each ASN office.  The notice will contain on the first page in the top right hand corner, the effective date.  In addition, each time you register at ASN for health care services, we will offer you a copy of the current notice in effect. 

Section G: complaints:

If you believe y our privacy rights have been violated, you may file a complaint with us or with the Secretary Department of Health and Human Services.  To file a company with us contact our privacy officer.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint. 

Section H: Other uses of Medical Information

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission.  If you provide us permission to use or disclose medical information, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose medical information for the reason covered by our written authorization.  You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of that care that we provided you.

Section I: Organized Health Care Arrangement:

As a provider of specialty care services in Sleep medicine, ASN participates as part of multiple health care contracts.  Patients are referred from primary care physician for diagnosis and treatment.  In order to provide quality medical care for its patients as well as provide details of care to patient’s primary care physicians as well as other physicians intimately involved in the care of a patient ASN may share, as permitted by law, your health information among these physicians for purposed of your treatment, payment, or health care operations.  This enables us to better address your health care needs. 

In addition, ASN may provide health information or insurance information hospitals for the purpose of billing the diagnosis and treatment of sleep disorders.